How does Deep Brain Stimulation Work?
What does deep brain stimulation do?
What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a neurosurgical procedure that involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or the electrical impulses can affect certain cells and chemicals within the brain.
The deep brain stimulation system consists of four parts:
. Leads (thin insulated wires) that end in electrodes that are implanted in the brain.
. A small pacemaker-like device, called a pulse generator that creates the electrical pulses.
. Extension leads that carry electrical pulses from the device and are attached to the leads implanted in the brain.
. Hand-held programmer device that adjusts the device’s signals and can turn the device off and on.
In deep brain stimulation, electrodes are placed in the targeted areas of the brain. The electrodes are connected by wires to a type of pacemaker device (called an implantable pulse generator) placed under the skin of the chest below the collarbone.
Once activated, the pulse generator sends continuous electrical pulses to the target areas in the brain, modifying the abnormal activity in that area of the brain that is causing symptoms. The deep brain stimulation system operates much the same way as a pacemaker for the heart. In fact, deep brain stimulation is referred to as “the pacemaker for the brain.”
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Deep Brain Stimulation (DBS) Side effects and Risks
Although deep brain stimulation is minimally invasive and considered safe, any type of surgery has the risk of complications. Also, the brain stimulation itself can cause side effects.
Complications of DBS fall into three categories: surgery complications, hardware (device and wires) complications, and stimulation-related complications.
. Surgery risks
Deep brain stimulation involves creating small holes in the skull to implant the electrodes, and surgery to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:
. Misplacement of lead
. Bleeding in the brain
. Stroke
. Infection
. Breathing problems
. Nausea
. Heart problems
. Seizure
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. Possible side effects after surgery
Side effects associated with deep brain stimulation may include:
. Seizure
. Infection
. Headache
. Confusion
. Difficulty concentrating
. Stroke
. Temporary pain and swelling at the implantation site
A few weeks after the surgery, the device will be turned on and the process of finding the best settings for you begins. Some settings may cause side effects, but these often improve with further adjustments of your device.
Because there have been infrequent reports that the DBS therapy affects the movements needed for swimming, the Food and Drug Administration recommends consulting with your doctor and taking water safety precautions before swimming.
. Possible side effects of stimulation
. Numbness or tingling sensations
. Muscle tightness of the face or arm
. Speech problems
. Balance problems
. Lightheadedness
. Vision problems, such as double vision
. Unwanted mood changes, such as anger and depression
. Hardware complications
Hardware complications include movement of the leads, lead failure, failure of any part of the DBS system, pain over the pulse generator device, battery failure, infection around the device and the device breaking through the skin as the thickness of skin and fat layer change as one ages.
How long does Deep Brain Stimulation Last?
The duration of DBS benefits varies from patient to patient, but in the majority of cases it lasts many years. Patients have now been followed for 10 or more years with DBS, and the general rule has been that if the symptoms still respond to dopaminergic medications, then DBS will continue to work.
What kind of results can you expect after having DBS?
DBS patients often see positive results, including sometimes regaining significant mobility. “Stimulation of the ventralis intermedius nucleus of the thalamus has clearly been shown to markedly improve tremor control in patients with essential tremor and tremor related to Parkinson disease,” the study said. “Symptoms of bradykinesia, tremor, gait disturbance, and rigidity can be significantly improved in patients with Parkinson disease.”
The procedure may decrease the use of medications, although patients should work with their doctors to adjust the device’s impulses to meet each person’s unique needs.
According to a 2019 study published in the Journal of Neurosurgery that addressed long-term outcomes for DBS patients, “Tremor responded best to DBS (72.5% of patients improved), while other motor symptoms remained stable. Ability to conduct activities of daily living (ADLs) remained stable (dressing, 78% of patients; running errands, 52.5% of patients) or worsened (preparing meals, 50% of patients). Patient satisfaction, however, remained high (92.5% happy with DBS, 95% would recommend DBS, and 75% felt it provided symptom control).”
Deep Brain Stimulation Success Rate
The study also observes that more than half of the Parkinson’s patients who received DBS survived for 10 years or longer. Considering that many individuals undergo DBS when alternative solutions become scant and decline becomes startling, an additional 10 years seems encouraging.